Periodic testing and planned obsolescence

Of course I’m doing my best,

Learning by taking a test,

If properly scored

I’ll pass the board

And post my comments in jest.

Synopsis: I’m a family practitioner from Sioux City, Iowa. In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work. In June of 2011 I joined up with the Community Health Center, which provides care for the underserved. I’m now working part-time, which, for a doctor, means 48 hours a week

I carry a Board Certification in Family Practice, which means that I finished a residency, I take continuing medical education (CME) at the minimum rate of 50 hours per year, and I keep passing tests. Being Board Certified in my specialty brings me flexibility, status, and money.

The Boards in 1982, my first year of certification, lasted, as near as I can recall, forever. I have been recertifying every six years ever since, because I prefer to have a one-year cushion in case I don’t pass the test.

Doing the math, over my career I’ll have to sit for the Boards once more than those who chose the seven-year option.

But the Board now offers a ten-year cycle, reasoning that making a doctor study more frequently but less intensively improves the chances of staying current. The process has become much more complicated; one doesn’t just sit in front of a computer screen for six hours, clicking on proper answer after proper answer. Nowadays one picks three Self-Assessment Modules (SAMs) from Part II, one from Part IV, and another two from Part II. I don’t know what happened to Part III. If everything has been completed, then one can take the exam.

The process is more complicated than that. For example, because 50% of my current situation entails inpatient work, and I only work 3 days a week, I wouldn’t have been able to distribute the patient surveys required for the standard Part IV, so I completed the alternate Part IV, Information Management.

As much as I dislike testing, the current run qualifies as the most enlightened examination I’ve been involved with. Prompt feedback, fair questions, and a chance to learn at every turn; the process ranks as educational rather than punitive.

The docs get the chance to comment on every test question, and now six modules into the process, I find I learn almost as much from the comments as from reading the references. Some of my colleagues impress me with their erudition, others with concerns for intellectual honesty. The Board, in my view, doesn’t check the comments often enough.

I phrase my comments in limerick form.

I still find questions that come down to “Guess what I’m thinking.”

I just finished a module on diabetes. If I would have taken it in a month, I would have gotten more questions wrong, because cutting edge information, just released in the last few days, has questioned the value of fish oil supplements. The Board validates questions, based on best clinical information at the time, and, with all the nuance and complexity available, avoids controversial areas, where large amounts of data exist on both sides of a clinical debate.

True today does not mean true tomorrow. Making the right decision for a particular patient involves moving targets on dancing landscapes, and the Board has to revise the examination more often than I have to take it.

Thus my certification carries inherent obsolescence, even if not planned.